Abstract

IJNM

Indian Journal of Nuclear Medicine

0972-3919

Society of Nuclear Medicine, India

ijnm-19-4-session-006

Session VI

122004

194148150

Synoviorthesis with Yttrium-90 Colliod in Haemophilia-Experience in a Referral Hospital

Shanthly

Nylla

¹Oommen

Regi

¹Vishwabandhya

Auro

²Srivastava

Alok

²Lee

Vernon

¹Department of Nuclear Medicine, CMC Vellore²Department of Haematology, CMC Vellore³Department of Orthopaedics, CMC Vellore

Ref. No: 45NSRTG9PO

AbstractObjectives

Intra articular injection of beta emitting radionuclides, or radiation synovectomy/ radiosynoviorthesis is an effective treatment in patients suffering from inflammatory rheumatoid and degenerative joint disease. This has also been found to be effective in chronic haemophilic synovitis causing recurrent haemarthrosis. With an objective to share our experience, we are presenting this paper.

Methods

Between November 2001 and April 2004 we treated 66 patients (92 joints). Sixty four of them were males-58 with Haemophilia A and the remaining 8 were diagnosed to have Haemophilia B. There were 2 female patients, one with Haemophilia B and the other with Factor VII deficiency. All the patients had history of recurrent episodes of haemarthrosis and restriction of movements. The average frequency of bleedingwas 1-2permonthin each joint. The youngest patient was 3 years old and the oldest to receive intra articular injection was 32 years old. Fifty three involved joints were in subjects above 12 years of age and 39 in the paediatric age group of upto 12 years. The radioisotope used for the synovectomy was ⁹⁰Yttrium colloid.

The intra articular injections were carried out along with the orthopaedic surgeon. Following the intra articular injection of ⁹⁰Yttrium colloid the concerned joint was rested for 24 hours. None of the patients had any local complications following the intraarticular injection. Of the 92 joints treated there were 73 knee joints, 12 elbow joints, 6 ankle joints and 1 hip joint. The dose injected was in the range of 111-185 MBq for knee joints, 92.5-159.1 MBq for elbow joints, and 111-148 MBq for ankle joints. One patient had bleed into the hip joint and he received 185 MBq. Follow up data was available upto July 2004 in 57 patients (69 joints). Following the first dose of ⁹⁰Yttrium, maximum 'bleeding free' interval in each joint was looked at.

Results

Among 11 joints followed up for more than 2 years, all (100%) were free from bleeding episodes. In 32 joints followed up for 2 years, 84.4% were symptom free with no episodes of bleeding. Among the remaining 26 joints evaluated upto 1 year, 88.5% have been doing well.

Conclusions

Radiation synovectomy is an effective modality of treatment in control of bleeding into joints in haemophilic patients. It is also safe and lacks any harmful side effects.

Key wordsSynovectomy SynoviorthesisChronic Haemophilic Synovitis⁹⁰Yttrium Colloid.

Estimation of Doses due to ^99mTc-Glucoheptonate by using Thermoluminiscent Dosimeter

Joshi

Sangeeta H.

¹Tandon

Pankaj

²Bhatt

B.C.

²Venkatesh

Meera

¹Board of Radiation and Isotope Technology, Bhabha Atomic Research Centre, Trombay, Mumbai - 400 085²Radiological Physics & Advisory Division, Bhabha Atomic Research Centre, Trombay, Mumbai - 400 085

Ref. No: 46SJDMG2

AbstractObjectives

To collect dosimetric data on BRIT radiopharmaceuticals, as to enable us to provide this information to our valuable users from Nuclear Medicine community.

Methods

Dose measurements were carried out in normal adult, Wistar rats using pre-calibrated LiF: Mg, Cu, P dosimeters (3 x 3 x 0.89 mm³). Doses received by different organs at different time intervals were measured by carrying out biodistribution at time points from 5minutes to 24hours. Using surgical adhesive tape, sterile plastic sachets containing 3 dosimeters each were placed on the body surface in close proximity to the organ of interest and other critical organs. ^99mTc-GHA was administered intravenously in tail through caudal vein. Animals were sacrificed at stipulated time and dosimeters were removed. Organs were collected separately and measured for radioactive uptake. Dosimeters were read in conventional TLD reader. To eliminate the radiation attenuation by soft tissues and obtain the actual dose received by organs, a minor incision was carried out in another set of similar animals and dosimeters were placed on organ of interest and other critical organs. After placing dosimeters, the wound was stitched using sterile sutures and needle. Biodistribution procedure was followed as per protocol stated earlier. Doses were computed after applying the calibration factor.

Results

Cumulative doses received by kidneys were 1.619mR/ ìCi and 3.822mR/ìCi, whereas those for liver were 1.04mR/ìCi and 1.42mR/ìCi for outside and inside placement of dosimeters respectively. Ratios of doses with placement of dosimeters inside to outside were 2.360 for kidneys and 1.36 for liver.

Conclusions

These studies indicate that, the dose estimation by Thermoluminiscent dosimeters placed on external surface can provide reliable data when corrected with proper factors.

Key wordsThermoluminiscent Dosimeter^99mTc-GHACumulative dosesTLD

Improvised Technique of ¹³¹I Dose Administration Using Venturi Principle

Rao

V V S Prabhakar

Sudhakar

Pushpalatha

Narayan

Manishi

Kumaraswamy

PradeepVenugopal

Nuclear Medicine Department, Nizams Institute of Medical Sciences Hyderabad

Ref. No: 47VVDMG3

AbstractObjectives

Novel and innovative method of high dose ¹³¹I administaration to patients.

Methods

A modified venturi technique has been devised to administer the activity directly from the vial with out opening it, using two IV cannula needles, IV tubing and a beaker of water. 14 such administrations were carried out in the Department of Nuclear Medicine Nizams Institute of Medical Sciences .The technique was easy, patient friendly and time saving with less radiation exposure as well. The residual activity in each vial after dose administration by this technique has been estimated in the Capintec dose calibrator. The entire procedure was explained to the patient on a dummy cold run to familiarize the patient with the procedure before the actual activity was administered.

Results

Dose administrations ranged from 3.5-25 mCi. The average time taken by the technician in handling the dose before consumption by the patient was only 30 s. The time taken by the patient to consume the entire dose ranged between 2-5 min. Residual activities left in the empty vial after consumption by the patient ranged from 45- 95 Micro Curies only.

Discussion

Conventional administration of ¹³¹I for therapeutic purposes is by opening the vial by decapping and adding water through a nozzled bottle and making the patient drink through a paper straw. This involves fair amount of handing of the activity containing vial by the technologist and time consuming as well, and gives increased radiation exposure to the radiation worker. The devised method is more patient friendly, gives less exposure to the radiation worker.

Conclusions

Administration of high dose ¹³¹I using the IV tubing technique is a novel technique of radio Iodine administration which reduces time of dose handling, and also radiation dose to the technician, besides being patient friendly.

Plain Radiographic Substitution of Ventilation Scan in Suspected Acute Pulmonary Thromboembolic Emergencies.

Rao

V V S Prabhakar

Sudhakar

Pushpalatha

Narayan

Manishi

Kumaraswamy

VenugopalPradeep

Nuclear Medicine Department, Nizams Institute of Medical Sciences Hyderabad

Ref. No: 48VVOTJ9

AbstractObjectives

Diagnostic approach to a clinical emergency.

Methods

Emergency pulmonary perfusion scan is done using 2 mCi of Technetium labeled MAA. Static imaging done in the 6 Views protocol of ant, post, two oblique and two lateral views on Siemens E Cam dual head camera. Scan findings compared with standard frontal radio graph of chest taken most recently. Pre test probability of PTE assessed on the clinical profile, rate of onset, and severity of symptoms, pre existing DVT, ECG Changes and D Dimer levels. Grading of the perfusion defects done in comparison with the extent of air space opacities on CXR are interpreted as High, Intermediate and Low probability of pulmonary thrombo embolism. (PTE).

Results

Analysis of 78 cases of clinically suspected acute pulmonary thrombo embolism revealed confidentiality in ruling out PE in 50% of cases, confirming the clinical diagnosis in 20% of cases, using the lung perfusion plain radiograph chest criteria. Still 30% of cases remained in the indeterminate category with intermediate probability of PTE.

Discussion

Acute pulmonary thrombo embolism is not an uncommon clinical emergency. However its specific diagnosis is constrained due to either paucity of available diagnostic studies, or invasive and cumbersome nature of investigations like pulmonary angiography, and ventilation scans. Near specific diagnosis of this condition is achieved by judicious usage of lung perfusion scanning and, plain radiograph of the chest. Substitution of plain radiograph of chest appeared to be an effective alternative to ventilation scans in acute clinical setting of suspected pulmonary thrombo embolism in its exclusion or confirmation. Subsequent follow up both clinically and imageologically proved that exclusion of pulmonary ventilation scan and its substitution with plain radiograph chest in association with lung perfusion scan, D-Dimer and ECG is an excellent clinico imageological work up in an emergency situation of pulmonary thrombo embolism.

Conclusions

Study revealed the usefulness of substitution of plain radio graph of chest substituting for the more cumbersome ventilation scan, thus saving patient time and arriving at a diagnosis in clinical emergency of acute pulmonary thrombo embolism.

Key wordsAcute Pulmonary Thrombo EmbolismPulmonary Perfusion ScanTechnetium Labeled MAA50PTE VQ scan

Pulmonary Deposition of Dry Powder ^99mTc-Fluticasone Propionate by Sunhaler®

Soni

P.S

¹Sandeep

²Ganesh

²Bhowmick

²Tilve

¹Board of Radiation & Isotope Techniques & BARC C/o TMC, Parel, Mumbai-400 088²Sun Pharmaceutical Advanced Research, Akota, Baroda-390 020³K.E.M. Hospital

Ref. No: 49 SP OT J16

AbstractObjectives

Inhalation aerosols, as a mode of administration represent a valuable means of targeting the medicinal agents to the pulmonary tract. Drugs are delivered by the inhalation route using variety of inhalation devices viz. nebuliser, metered dose inhaler and dry powder inhaler (DPI). Drug for inhalation route requires very fine particles of 2-5 mm AMAD to be delivered to the lungs. However, it is difficult to predict the exact dose delivered through these devices and to determine the amount of drug deposition in the lungs. An attempt was made to establish a technique to assess the pulmonary deposition pattern.

Methods

Drug delivery to the lung using a dry powder inhaler (Sunhaler®) was studied in human volunteers to elucidate correlation with the in-vitro deposition studies and the effectiveness of Sunhaler® in in-vivo pulmonary deposition. Initially, a technique for radiolabelling of the corticosteroid, Fluticasone propionate, with a radionuclide ^99mTc was developed and checked if the labeling process changes the formulation behavior. To study this, ^99mTc in MEK along with the drug (Fluticasone Propionate) was sonicated to evaporate to dryness, which was then mixed with the lactose. The labeled formulation is filled in a Sunhaler®. In-vitro deposition studies with ^99mTc labelled fluticasone propionate and unlabelled fluticasone propionate was performed using a Next Generation Impactor (NGI). The labeled DPI formulation showed AMAD (4.61 mm) with GSD (2.49 forn=6) andrespirable fraction (Fine Particle Fraction FPF) of 37.87%. In contrast the unlabeled formulation with MMAD (3.68 µm) with GSD (3.99) and respirable fraction of 33.67%, which proved that there was no significant difference between labeled and unlabelled fluticasone, indicating that the drug labeling process does not significantly alter formulation behavior. Clinical trials were conducted on 8 volunteers, free from any disorder symptoms associated with respiratory tract, using ^99mTc- fluticasone formulation. The approval of local ethical committee for the study and informed written consent was obtained from each volunteer. Each volunteer inhaled from the DPI at a tidal volume followed by 5-10 s breath holding in front of the detector. Posterior views of the oropharynx, chest and stomach were quantified with gamma camera. Static and dynamic images were recorded for 5 minutes. The percent depositions in lungs were quantified using posterior view. Activity in the device after inhalation was measured.

Results

The delivery of drug by oral inhalation indicated that the effective respirable fraction was (25%), while the rest of the drug was deposited in the oropharyngeal region and device itself. The in-vivo results corroborated with the in-vitro study.

Conclusions

The study concludes that the Sunhaler® effectively delivers dry powder inhaler formulations to the lung and scintigraphy is a method of choice for biological investigations in the development program for novel delivery devices and formulations.

Key words^99mTc labeled Fluticasone PropionateDry Powder Inhaler Sunhaler ®